Welcome, everyone, and thank you for joining this Quality Summit Hot Topics Session focused on learning how Mississippi is tackling statewide quality improvement initiatives focused on improving STEMI mortality. My name is Connie Anderson, and as the CAHPS PCI Registry and Chest Pain MI Registry Product Manager, I'll be moderating our discussion today. I'm so excited to welcome back Dee Howard, the Executive Director of the Mississippi Healthcare Alliance, and Keisha Medley, the System Cardiovascular Registry Director at Baptist Memorial Healthcare. I'm sure many of you listened to them share their early experiences with COVID-19 pandemic during last year's Quality Summit and heard how Chest Pain MI Registry participating hospitals and the Mississippi Healthcare Alliance collaborated to coordinate a statewide response. Today we are joined by Brandy Williams, the Clinical Outcomes and Project Coordinator for the Cardiac Critical Care Service Line at Memorial Hospital at Gulfport. As we take a closer look at what and how the Mississippi Healthcare Alliance works to affect change across the whole of Mississippi, and, of course, how the hospitals of Mississippi collaborate with the Mississippi Healthcare Alliance to implement change. I hope you take a moment to become better acquainted with these impressive speakers by reading their bios. Now let's get started. Dee? Thank you so much, Connie. We're pleased to be here today to present again with you about the Mississippi State of Mind. The Mississippi Healthcare Alliance began in August 2009 and was founded with about five hospitals, and we started out very small, but now we have grown with our membership being 21 PCI centers and 68 stroke hospitals. The mission of the Mississippi Healthcare Alliance is to improve the health status of Mississippians. Our vision is to unite stakeholders to bring about an alignment of efforts that reduce morbidity, mortality, and cost associated with problematic disease processes that plague our community. Mississippi's STEMI system of care was developed in 2010 and adopted by the State Department of Health as a voluntary system of care in 2011. All STEMI receiving centers collect and submit data to the ACC NCDR chest pain in my registry. We also have at the Department of Health a STEMI performance improvement committee where hospitals unblind their data and we talk about each hospital's performance confidentially. This provides feedback as needed for the system's improvement at a local level. The Mississippi State Department of Health provides a venue for all hospitals to unblind their data at a quarterly performance improvement committee meetings. All the committee members sign confidentiality agreements for the meeting content and hospitals are tasked with addressing the outliers. With Mississippi Healthcare Alliance quarterly statewide meetings, we review our quarterly aggregate data with state versus nation and we track trends to monitor our progress on different metrics. The goal here is for us to be able to see where we need to make improvements and we rely on the high performing hospitals to help other hospitals make those improvements and share best practices. This is a map of the state of Mississippi. We have divided the state into three regions, north, central, and south. As you can see on the map with the red stars, those are the STEMI receiving hospitals and in the yellow, those are the STEMI referral hospitals. We have seven STEMI receiving hospitals in the north, eight in the central, and six in the south. We have regional STEMI coordinators that are handpicked. These are the most experienced and knowledgeable providers in their regions and their roles are outlined here. They are to help to maintain a coordinated and harmonious regional STEMI system across the state. They facilitate new hospital STEMI coordinators with learning their role and assist with statewide and regional Healthcare Alliance educational offerings. Each STEMI receiving center has their own receiving center coordinator as well who provide feedback at their STEMI team hospital meetings of their data. They provide feedback and education to non-PCI centers and EMS on a case-by-case basis with the feedback loop being very important to EMS and referral hospitals. They also attend bi-monthly webinars that are provided by the Mississippi Healthcare Alliance. This is a picture of the Mississippi AMI mortality, which we saw with our first data collection starting in 2010, Mississippi's mortality was 6.8 versus the nation of 5.8. As we continue to work diligently across the state, you can tell in 2016, our mortality was below the national median and it has remained very low and very close to the national median through the year 2017. We're very proud of that. The Mississippi Healthcare Alliance is focused on improving the health status of all Mississippians by uniting stakeholders to reduce morbidity, mortality, and healthcare costs. Next to share with you is Keisha Medley. She is the North Regional STEMI Coordinator and she is the System Director of CV Registries at Baptist Memorial Healthcare System. Thank you, Dee, for such a warm introduction. I am Keisha Medley and I'm honored to share the corporate role in reducing STEMI mortality. I will share the highlights of what data is shared with the state, how it's shared, who presents it, and how state initiatives fit into the quality improvement across our tri-state organization. Our organization consists of 22 hospitals in a tri-state area. We have almost 3,600 licensed beds, exceed 500,000 annual ED visits, and have a heart transplant and advanced heart LVAD program. We perform about 3,500 PCIs and 300 TAVRs last year. Our footprint is large in Mississippi with four primary PCI hospitals and seven referral and critical access hospitals. We have been participating in the NCDR registry since 2012 and have continued to use their tools and resources to measure our performance and drive improvement. Taking it to the next level, we have demonstrated our commitment to our community and patients by achieving five different accreditations. We have a total of nine chest pain centers, six PCI STEMI receiving centers, and three referring centers, five cath labs, one heart failure, and one AFib accreditation. We are committed to quality and delivering the highest level of care. It is imperative that we have hardwired processes based on best practice. Some of our practices have had to adjust due to the nature of the pandemic. For example, we had hardwired processes at our PCI receiving centers such as bypassing the ED with STEMI patients when activated in the field. However, the challenge became how to remain timely while providing for the safety for our staff and our patients. We have adjusted to the new normal and it has prepared us for our latest surge in this pandemic. Our relationship with the Mississippi healthcare lines began in 2012. We have remained connected via emails, bimonthly calls and meetings, and annual conferences. Three of our primary PCI facilities are located in the north region and one is in the central region. Over the last nine years, we have truly developed a fluid relationship with open communication and mutual support. This was clearly evidenced by their immediate action and STEMI process of care revisions when the pandemic first hit. We know that we are a phone call away from their support and connection to the State Department of Health. The organization of our healthcare system includes our centralized registry departments direct reporting to the CV service line administrator rather than the quality department. This allows direct oversight of all CV registries activities including addressing any process barriers or identifying trends. Our collaboration with leadership and physicians at a system and facility level facilitates organizational strategies and ensures we have the right people at the table to move us forward. This is evident in our CV consensus teamwork where we refine our order sets, clinical pathways and agree to adopt new science and best practice to ensure every patient in our system has the equal opportunity for the best outcome. In addition, we hold state, regional and national positions that allow us to use these practices to influence and support our colleagues across the spectrum. Our centralized registry team ensures the integrity and accuracy of the data that we report publicly. Our outcomes data is compared to our state initiatives to keep us on target. STEMI mortality reduction is a major concentration in Mississippi, so it is important that our STEMI coordinators at each facility capture the patient's experience including all of the timeline events in a very timely manner and provide feedback to those key stakeholders. This information is also imperative to facilitate accreditation, national star ratings and performance achievement awards and to move us forward with financial and strategic initiatives. We remain relevant within our industry which increases our market share. We created this document that we refer to as a STEMI hearts form to provide a phase of care analysis of the timeline and delivery of care at each of our PCI centers. The pre-hospital phase outlines conditions and timeline of EMS response and the care team, their symptom onset time, the care delivered and identifying any delays or special conditions of the patient prior to arrival. The emergency department phase summarizes the care delivered, the care team members and the timeline of the EKG lab and team activations. And lastly, the cath lab phase indicates the time of arrival to the cath lab, device time, care team members and the outcome of the intervention. For the state, this is important information in a very concise report that outlines all key components that support the state focus metrics. Each facility STEMI coordinator, as Dee explained earlier, is required to personally attend the quarterly state PI meetings. This closed meeting is confidential but allows the open discussion of any outliers such as timing delays of referring facilities, the EKG prior to the arrival and proponent turnaround times and any other element that might contribute to mortality or a missed care opportunity. As discussed, this form is an exceptional tool. This form is completed and shared by the PCI facility STEMI coordinators to all stakeholders including the physicians, care teams, EMS, referring facility, cath lab and leaders within 72 hours of STEMI occurrence. The EMS and care teams use this information including the pre and post intervention images and the EKG for ongoing education within their department. This important right now look at each STEMI case evaluates any missed opportunities as well as to celebrate success with the care team. We have shared our form and distribution process throughout Mississippi and this has also been well received within the Arkansas and North Carolina's STEMI alliances. Further, this tool satisfies our chest pain center accreditation requirements. Having evidence-based best practice care process expectations outlined by the Mississippi Healthcare Alliance and the state of Mississippi, we have incorporated those practices into our non-Mississippi hospitals. Not only does this ensure consistency and provide the foundation for high integrity data reporting, it also promotes high engagement among our physicians who perform these services across state lines. We utilize the multidisciplinary consensus teams and leadership to clearly define the goals, explain how they will be measured and to lock in those performance steps it will take to meet our goals. Providing granular level feedback monthly to those teams has resulted in high engagement at all levels regardless of which state the hospital is located. This is one of the greatest values of having this strong relationship. Our centralized registry department is staffed by CV nurses and techs that have undergone dedicated and focused training of registry abstraction and reporting. This provides strength and ownership of the data because the experience is captured by those who have actually experienced the delivery of care they are reporting. They maintain active participation with the registry RSM calls, scientific literature, webinars and other dedicated learning. Also, they are highly efficient and cross-trained to more than one registry which adds value and support. The team also provides actionable and timely data results to key stakeholders to drive process improvement and our abstraction goals are 16 days from the hospital discharge to the final abstraction to ensure monthly reporting goals are met. The team is defined as all multidisciplinary members involved in the patient's experience. This includes physicians, coordinators, nurses, leadership and the registry abstractor. Feedback is provided or clarifications are requested at the time of abstraction and direct communication with our boots on the ground STEMI coordinators at each facility allows for face-to-face discussion and clarification of elements. The physicians feel heard and supported. When abstractors are present in the meetings, it allows for them to educate on those required documentation elements and explain how the case will impact the data. They are seen as valuable members of the team instead of the we versus they. We provide onboarding to each CV physician, leader, surgeon or abstractor to ensure they understand the goals, the tools and their report. This is particularly important as we educate physicians on proper documentation of type one in STEMI versus type two MI. Understanding how to accurately document a non-MI troponin elevation is essential to distinguish a true MI case. As coding changes in 2017 designated an ICD code for type two MI, the NSTEMI should only be used when referring to a type one MI. If an MI due to supply demand mismatch occurs, type two MI should be used. Only type ones are counted in the mortality scores. Using our AMI consensus team to distribute this education to cardiologists, intensivists, hospitalists and ED physicians provides the stage for support and reinforcement by our physician leaders across our entire organization. By accurately reporting these correctly, our system wide and state level adjusted mortality rate will decrease. This education was also presented by one of our Mississippi Healthcare Alliance physician leaders during our most recent symposium. This further demonstrates the dedication and commitment of our physician leaders to reduce mortalities in our state by supporting each organization statewide. Physicians have adapted to the consistent messaging on reports, structured reports and have high levels of engagement. Collegial discussions opened by our physician champions allow just enough healthy competition to enhance improvement. Providing immediate feedback promotes PDSA responses to turn the tide within the corner rather than later. And again, consistent messaging, using the same terms, providing the same source documents and providing SNPs of the definitions or the guidelines truly helps to maintain the accuracy and integrity of the data. So how does this matter to the state? Well information is reported timely and accurately into the chest pain MI registry prior to deadlines and we obtained a green status to be included in reporting. We advise the state of registry changes and reporting considerations that might impact operations statewide. We provide education at symposiums and in those quarterly forums as requested such as metric changes, risk adjusted definitions and others. And we get to serve as subject matter experts and offer non-competing support and training to new coordinators and data managers in their new roles. This provides guidance and consistency of reported data in efforts to reduce those outliers. So in summary, there has been a system-wide impact of using state-led initiatives to drive cardiac care. We are committed to reducing the STEMI mortality rates in the state of Mississippi by utilizing our structured model to provide timely, accurate and actionable data and documentation education to our facilities and to the state. STEMI data is reported by the facility-based STEMI coordinators to all key stakeholders within 72 hours which quickly provides a snapshot of the patient's experience and outcomes. Our high-performing centralized registry department has ownership and accountability of the data that is abstracted after discharge and provides granular data reports and education to internal care teams and leadership as well as equipping the STEMI coordinators with important education about state-focused metrics monthly. Consistent messaging, structured reporting and ongoing education promotes high engagement and satisfaction. This model also provides support and ongoing education to further the mission of the state Department of Health via the Mississippi Health Care Alliance to reduce STEMI mortality. At this time, I would like to introduce a fellow colleague, Brandy Williams, who will share her hospital's experience. Brandy serves as the Clinical Outcomes and Projects Coordinator at Memorial Hospital at Gulfport. Welcome, Brandy. Thank you, Keisha. I'm Brandy Williams and I'm excited to share my hospital's role in the Mississippi Health Care Alliance to improve STEMI care and reduce STEMI mortality. I'll describe how the registry data is shared on the state level and the hospital level, examples of communicating with stakeholders, our performance improvement model and the benefits of having a statewide network. Here is our main hospital in Gulfport, Mississippi along the Mississippi Gulf Coast. We're just a few blocks from the beach. Memorial is a growing hospital system in South Mississippi. Our main hospital is located in Gulfport. We have 328 inpatient beds. We have four cath lab procedure suites and our designated STEMI receiving center. We have a smaller rural hospital just north of us in Stone County and we have an agreement with Merit Health in Biloxi, just 14 miles east. Memorial Hospital values registry participation for many reasons. The hospital strives to fulfill our mission of building a healthier community. We participate in the registries that target our key patient populations and this guides us to provide evidence-based treatments, achieve excellent patient outcomes, deliver timely and optimal care. Our hospital has been part of the Mississippi Healthcare Alliance Network for almost 10 years. Our partnership shares the value of chest pain in my registry data to improve the outcomes of our STEMI patients. Years ago, we signed an agreement to share specific data with the Mississippi Healthcare Alliance, demonstrating transparency and the goal to drive improvement efforts. The Mississippi Healthcare Alliance and the State Department of Health facilitate a STEMI PI committee. We meet quarterly to review STEMI quality metrics as a statewide group confidentially. The Mississippi Healthcare Alliance links hospitals to each other and allows hospitals to share strategies to improve outcomes. We develop resources within our region and all across the state. We also identify physician leaders in specific areas and can use these champions to help us drive change. I would like to share our hospital's unique structure for the cardiac registries. Our chest pain MI, cath PCI, and cardiac surgery data registry and abstraction is not within the quality department. It is in our cardiac and critical care service line. We believe that keeping these registries within the cardiac service line gives us the ownership for the outcome metrics. On the state level, the Mississippi Healthcare Alliance is another layer of ownership. We utilize various ways to communicate new information, metric changes, improvement strategies, and share specific data metrics on STEMI. We do this through our bimonthly STEMI coordinator meetings, our regional and state symposiums, and our quarterly STEMI PI committee meetings. These are just a few examples of how our hospital shares the registry information with the key stakeholders. We use data dashboards with trends of metrics that are specific to each group we're presenting to. We set goals for these metrics. We discuss new processes to develop to achieve these goals. We share emails with real-time feedback on STEMI time goals. We post flyers in the cath lab. We go to staff meetings and provide presentations. We also do special presentations for key groups of staff. We recently held a special two-hour session for our cardiology advanced practice providers. We scheduled it in an afternoon at 530 when they were done with rounds. We had over 30 cardiology advanced practice providers in attendance. We provided dinner, we presented data dashboards, trends, and goals. It was a great networking opportunity, and this group shared ideas and strategies that worked well for them. We also provide ongoing education to new staff and update the current staff as things change. And it's also very important to celebrate our successes. Our hospital's performance improvement model utilizes Lean Six Sigma strategies. We use the DMAIC process for most of our projects. Here are the key concepts of Lean and Six Sigma. Lean is continuous improvement in the pursuit of perfection. It has the utmost respect for people and teamwork. It looks at the long-term vision and focuses on the value and quality in the eyes of the patient. It strives to eliminate waste and variation with standardizing processes. Six Sigma, in turn, defines the very specific problem that needs to be fixed. It measures baseline performance data, and this is one of the many ways that we leverage our registry data. We analyze the data and identify root causes, and you do this by asking the doers of the work and listening to them. This is very, very important. We also implement solutions and measure improvement in the baseline data. Once you find an effective solution, you have to ensure improvements become embedded in the culture, and this is often the hardest step. We highly recommend utilizing technology. Our electronic medical records, alerts, mobile apps, emails, automated reports are all really good ways to look and analyze data regularly. Throughout our tenure journey, Memorial Hospital values the partnership we have with the Mississippi Healthcare Alliance. On this slide are the STEMI metrics shared with the Mississippi Healthcare Alliance. They are key to improving STEMI patient outcomes across the state. The focus is on the full continuum of the STEMI patient, from the moment they call 911 to their discharge from the hospital. The Mississippi Healthcare Alliance allows high-performing centers to share success strategies with centers that need improvement. The Mississippi Healthcare Alliance provides evidence-based, standard protocols to follow. Lastly, the partnership is an invaluable opportunity to network with the cream of the crop from your region and across the state. Troubleshoot ways to overcome any roadblocks that you may encounter at your own facility and achieve statewide efforts to reduce STEMI mortality in Mississippi. I'd now like to reintroduce Dee back to summarize the Mississippi State Healthcare Alliance and our efforts with the Mississippi State of Mind on reducing STEMI mortality in our state. Thank you, Brandy. In Mississippi, we own our chest pain MI registry data. And by that, I mean that we confidentially and carefully review each quarterly report and use those outcomes for opportunities for improvement at our State Department of Health PI Committee meetings. There we can tell which hospitals are meeting or surpassing metrics and which hospitals need to make changes to improve. All discussions, as I said before, at PI meetings are confidential. So that means that hospitals are more likely to share when they know that the information is confidential. The Mississippi Healthcare Alliance is focused on improving the health status of all Mississippians by uniting stakeholders to reduce morbidity, mortality, and health care costs. COVID-19 impact on the STEMI care in Mississippi was tackled by our registry data. We could tell that our aggregate data was revealing that our state was slipping on some important metrics over 2020, such as first medical contact to PCI, transfer time to primary PCI, and risk standardization mortality. The reasons why, or the root causes, is we pared it down to realizing that there was no data during a transition to the chest pain MI version 3. And when you don't look at data, you don't know how you're performing. You don't have data to look at. STEMI patients in 2020 seemed to be sicker as well. They were presenting late. Some were COVID positive, and some were presenting already in cardiogenic shock. Also we found that there could be coding errors, which Keisha mentioned earlier in her presentation, that data abstractors were including type 2 MIs in mortality, and we only include type 1 MIs in mortality data. The most important metric that we reviewed is mortality, and we now have seen that there's been a gradual rise in our risk adjusted mortality since the other slide that I showed you earlier in 2017, showing where we were almost equal to the nation in mortality. We've seen just a gradual increase in our mortality to where now our 2021 data shows that Mississippi is above the nation in mortality rate. We did not like this one bit, so we made a statewide plan to go back to the basics. In July of this year, we had three different regional symposiums. We titled those symposiums Reset, Refocus, and Reeducate, Getting Back to the Basics. The data that we had seen provided the impotence for regional symposiums to focus on those metrics that needed improvement. We knew that hospitals needed to be reengaged in education and reeducate those new staff members that may not be aware of our mission in the Mississippi Health Care Alliance STEMI system of care. All the symposiums were held on the same date at the three regional venues. We had one in North Mississippi, Chippealow, Central, and Jackson, and in South Mississippi in Hattiesburg. The agendas and the presentations were all the same, but the presenters were from local regions. Everyone in the local region generally knows one another, can identify with what goes on in that particular part of the state. We included EMS professionals, nurses, physicians, and hospital administrators. We focused on improving outcomes with our continuing education strategy, and we revisited our STEMI protocols with the non-PCI centers. STEMI protocols are very important for education in non-PCI centers. It allows education for how to manage a patient that's going to be prolonged in their delivery of open artery at the PCI center, that may have to stay at the non-PCI center for a while to receive a lytic. There's a lytic protocol, and then there's a primary PCI protocol. It was found that before protocols were set, that each hospital had their own set of protocols. We wanted them to be simple, concise, easy to follow, and easy to understand. We laminated these posters and presented them for each of the hospitals to take back to their emergency departments and hang on the walls where doctors and nurses could easily refer to them. We are, in spite of some of the lags in the metrics, extremely proud of these 10 hospitals that achieved award recognition status in 2021. We had eight platinum receiving hospitals, one gold, and one silver receiving hospital. And Mississippi Health Care Alliance congratulates the Baptist Memorial Hospital's success because 100% of the Baptist facilities were awarded platinum. All six of Keisha's hospitals that provide STEMI emergent care were awarded the platinum quality award. We look to those hospitals to share their best practices between other hospitals and encourage them to share how they have been so good in their care and provided outstanding STEMI care to patients. That is one of the main, I think, great things about Mississippi Health Care Alliance is sharing a best practice with other hospitals that need quality improvement. Our continued goals for the Mississippi Health Care Alliance and the STEMI system of care are to continue to achieve, maintain, and provide a sense of excellence in our care across the state. We're going to continue to review our metrics, whether they be good or bad. We can find places where we can make improvement across the state and collaborate with all of our Mississippi hospitals. We can include STEMI receiving and STEMI referral hospitals with education and re-education. We'll continue our bi-monthly webinars with STEMI coordinators and data collectors to stay connected and on track and maintain that commitment to quality cardiac care. So working together as trusted partners of the Mississippi Health Care Alliance, we will continue to take steps toward improving cardiac outcomes at the hospital, the healthcare systems, and the state level. Thank you so much for your attention today, and thank you, Keisha and Brandy, for your participation with the Mississippi Health Care Alliance. Thank you, Dee, Keisha, and Brandy for all the time and effort you've put into this presentation. Now I have some questions for you, and I'm going to start off with you, Dee. Brandy noted that there are bi-monthly calls. Can you tell us what happens there, what kind of topics are discussed, what is the format, and what is the goal of that bi-monthly call? Yeah, sure. We start off with a welcome and introduction of new STEMI coordinators. We have reports from the regional STEMI coordinators, any struggles that they are having in their particular region, any successes, any educational offerings going on in their region. We do it very informally. I like that format, putting everybody at ease to just discuss whatever's on their mind. We talk about any chest pain in my registry updates. We have AHA updates from our Mississippi quality representative. I review what's going on with the CARES registry that Mississippi Health Care Alliance participates in. We also talk about any updates in targeted temperature management education, and we also have a monthly call for those TTM teams at STEMI-receiving hospitals. We talk about the utilization of the Mississippi STEMI listserv as a way also of communicating with one another outside of the bi-monthly calls. So it sounds very much like that forum, and the informality of it helps to break down any barriers that folks might have, whether it's being intimidated by somebody else or just not feeling comfortable talking about things that are, you know, personal. We all get pretty personal about what we're doing in our own hospital. Would you say that it creates a sense of camaraderie? And Keisha and Brandy, I welcome your comments as well. I certainly think it does. People get to know one another. And one of the features about the meeting that I like as well is that each of the three STEMI coordinators representing the state have the opportunity to bring feedback to the entire forum about activities that are happening within our region. For example, I have the north region, and so we have the opportunity to introduce any of the new members to that team or discuss any of the variables. Maybe something's happening within our EMS organizations up in the northern state that's not impacting the southern state. We at least get to bring that to the stage. So it really allows us to keep everyone well informed, but to represent our sections at that time. Yeah, it sounds so interesting. We used to be able to get together in person, and Dee would travel to different regions of the state, and we would get to sit across the table and meet the people we talked to on the phone all the time, and we look forward to getting back to that soon. Oh yeah, I think we all miss seeing each other in person. So Keisha, a question for you. Initiating a quality improvement activity of any kind, I don't care how small it is, is a hard and laborious effort, and yet you mentioned several quality improvement processes which are hardwired into the care of the PCI receiving center, such as bypassing the ED with STEMI patients that were activated in the field. And while you've had to put that process on hold because of COVID, what I want to know is how did you initiate that type of process across the whole of the Baptist system hospitals? And I don't mean for you to tell us step by step how did you get that done, but how do you build collaboration so that everybody wants to do that? Because that, I feel, is one of the hardest things about a quality improvement initiative. That's a great question, Connie, and I thank you for that, because what we've learned is no matter the registry, no matter the reason, when we have so many members that have such great perspectives or experience or education, it's so important to identify those key players through our consensus teams. We bring each one to the table so that we can hear and stay as up-to-date and as current as possible. That way everyone, each facility, not just our major flagship facility, but each of our facilities across our system has the opportunity to be heard and to discuss some of the variables there. One example is when we adopted the PULSERA across our system, our EMS, our ED teams, our cath teams, and our cardiologists. They all receive equal communication at the same time. They see the images, they see the patient details as they're happening, as they're unfolding. They're shared simultaneously and can be delivered accordingly, which includes when the teams were activated, whether the patient needs to bypass the ED, or if the cardiologist chooses to cancel that STEMI. Everyone understands, everyone gets the message at the same time. Communication is so key. For that even, we appreciate the Mississippi Healthcare Alliance for providing financial support to our Mississippi hospitals for that technology to help equip us with the tools that we needed to enhance that communication. That's one of those great examples for that. Yeah. Well, and Dee snuck in that slide of all of your hospitals getting platinum. That's like crazy. Maybe we'll have to have you do a whole presentation next year all by your lonesome. All right, Brandy, I wanted to tell you that I appreciated your reference to how the data in the registry is all owned in the place, or lives in the place where it has been used in your cardiac department. Can you tell us how being in a relatively small hospital and then coming to the state meetings and collaborating with your peers across the whole state of Mississippi has influenced your practice, or your QI efforts, or even your registry participation? Well, at the meetings, at the regional conferences, I listen out and take note of who's doing really well with different things. I've reached out to Keisha in the past and talked to her about their data abstraction process and the registry in general. I've reached out to Hattiesburg, our physician leader there, Dr. Thad Waits, and talked to him about documentation that we can use to improve our documentation at the hospital. We've also reached out to colleagues in Jackson and gone on a site visit to see how we could set up a radio lounge. The opportunities are endless. Lots of different people across the state doing lots of great things and always willing to help and share how they're doing them. Yeah, and Keisha's in the north and you're in the south, right? So that's really a great example. I literally just put that together. All right. Let's see here. Dee, I wanted to get back to a question for you. There were some clear gains in reducing STEMI mortality early on after you started this initiative, and that was demonstrated in that earlier slide through, say, 2017. But now, looking all the way through 2021 quarter one, we see that some of those early gains are slipping. And you mentioned some of the reasons why that might be happening. But I'm curious, even beyond the best processes and the best healthcare teams, we still need to educate our patients. And so I'm curious if you're doing anything to help influence patients to not wait to come in, or what efforts are you undertaking? Yes. Yes. So the Dial, Don't Drive campaign has been very important to us for several years. We've worked with a marketing ad agency to create commercials, and we use our own EMS people and our medical volunteers, doctors that are familiar in their region. For example, we would have a cardiologist that works in North Mississippi to do a commercial for North Mississippi. That kind of thing, so that people see on the TV how important it is, and they say, oh, I know him. He works at my hospital. And they take it to heart that Dial 911 is the way to go with symptoms of heart attack and stroke, that they are emergencies. And the cost of those commercials and the airing of them across the state is funded by the Mississippi State Legislature, of which the Mississippi Healthcare Alliance gets funding each year, we hope. We have to lobby, but we do hope that we continue to get funding each year so that we can continue these important initiatives. That's so impressive and so incredible that you have that kind of support within the state. So Dee, you've talked extensively now about the effort of the Mississippi Healthcare Alliance and the hospitals in Mississippi to reduce STEMI mortality. Does the Healthcare Alliance focus on any other health care concerns, and are they promoting other QI efforts to focus? Oh, yes. Of course, STEMI was our number one first child, but then came along the Stroke System of Care in 2014. And we have really done a lot with stroke care in our state by having hospitals self-designate what level of stroke care they're able to provide. We have three level one stroke hospitals in the state that do endovascular clot retrieval. And we do very similar, what we do with the STEMI System of Care, we do with Stroke System of Care. We also know that it's very, very important for our out-of-hospital cardiac arrest patients, not just those who have a STEMI, but for all the patients that have out-of-hospital cardiac arrest who get ROSC and have no neurological function to get targeted temperature management. AHA and ECU committees have made that a Class 1A recommendation, meaning everybody does it. Patients qualify for it. They need it. We know that it improves outcome. And we have those groups within each STEMI receiving hospital that really focuses on improving and not missing opportunities to treat patients that qualify for TTM. We have the CARES Registry where we are concerned about our overall outcomes from out-of-hospital cardiac arrest. And we are now working on sepsis protocols to develop another system of care in Mississippi. So that is being formulated right now. Sepsis protocols for EMS and for hospitals are just being written, and we will roll that out probably within a year or so. I'm tired and excited listening to you. Yeah, yeah. People first. It's a lot of fun. It keeps me busy. People think, oh, I just do STEMI, but it's really a lot more than that. It is. So much fun. Wow. That's why it takes everybody working together to get it done, and a lot of good communication. And like I said, we wouldn't know each other if we didn't have an alliance to where we recognize faces. We know each other on a first-name basis. We can pick the phone up and call each other. It's just a real great thing to have that cohesiveness. Well, and we didn't talk about it, really, but I think what you guys all used the little arrows, and then, Dee, you had the circular thing at the end, and it right away made me think about the PDSA cycle, right? That whole revisiting, reevaluating constantly. I think on that note, we'll end now. And I want to thank you all, Brandy, Kesha, and Dee, for joining me and for all the time and effort you put into developing this wonderful presentation. I'm hopeful the many examples you provided of how you communicate with each other, how you freely share data, and most especially how everyone revisits and reevaluates the goals and objectives in this concerted effort to reduce STEMI mortality, that all of that will motivate our fellow Quality Summit attendees while also providing them this wonderful example of a successful collaboration. Thank you, everyone, for watching this presentation. And please let us know if you have any questions. You can email us at ncdr at acc.org. Thank you.

Connie Anderson

Mississippi

STEMI mortality

Mississippi Healthcare Alliance

collaboration

communication

quality improvement efforts

cardiac care